Conjugated jaundice investigations - part 1

Warning

First Stage Investigations (Term)

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These refer to the well child with prolonged conjugated jaundice.  Items in blue should be carried out in all term infants with conjugated hyperbilirubinaemia.  The items in green should be considered and the decision made (and documented) with a consultant in terms of appropriateness and timing of these investigations.

First stage investigations (Term)

Investigation

Specimen Tube

Comments

Results

Haematology

FBC & reticulocyte count

EDTA

 

 

Coagulation

Sodium citrate

If PT/INR prolonged give 300mg/kg of IV vitamin K and repeat 12 hours later.  If still prolonged contact a liver unit.

 

Group and Coombs

EDTA

 

 

Biochemistry

U&E, bicarbonate, Lactate

Lithium heparin

 

 

Total Bilirubin

 

 

Direct (conjugated) Bilirubin

 

 

LFTs

ALT& AST:non-specific cellular enzymes.

 

Gamma GT

GGT: ductal enzyme: elevation suggests obstruction. Cholestasis with a normal GGT may suggest Progressive Familial Intrahepatic cholestasis.

 

Calcium

 

 

Phosphate

 

 

Cholesterol/Triglycerides

 

 

Blood sugar

Fluoride oxalate

Pre feed in the first 24 hours of admission

 

Microbiology

Blood culture

 

 

 

Urine culture

 

 

 

TORCH screen

Plain tube

IgM to Toxoplasma, rubella, CMV, herpes

 

Hepatitis A,B, C and E

 

 

Urine CMV

 

 

 

Blood for HSV PCR, Stool for enterovirus

 

 

 

Metabolic

Galactose-1-phosphate uridyl transferase

1ml EDTA (RHSC)

To exclude galactosaemia in infants who have fed milk and who have not received a blood transfusion

 

a1 antitrypsin level & phenotype

 

To exclude α1-antitrypsin deficiency

 

Plasma amino acids

 

 

 

Urine amino/organic acids

 

 

 

Urine dipstick for protein

 

 

 

Endocrine

Thyroid function tests

 

 

 

Cortisol (preferably after 4 hour fast)

 

If low should have a short synacthen test

 

Imaging

Abdominal ultrasound following a 4 hour fast

 

To see if gall bladder present and if had a choledochal cyst

 

Stools

Consultant to see stool colour (photograph specimen)

 

Editorial Information

Last reviewed: 14/07/2023

Next review date: 14/07/2033

Author(s): David Quine.